Abstract:

A priority clinical and research agenda in mood and anxiety disorders is to identify determinants that influence
illness trajectory and outcome. Over the past decade, studies have demonstrated a bidirectional relationship between the
gut microbiome and brain function (i.e., the microbiota-gut-brain axis). Probiotic treatments and developmental analysis
of the microbiome may provide potential treatments and preventative measures for depressive and anxiety disorders. This
systematic literature review aims to identify original studies linking the gut microbiota to major depressive disorder and
anxiety disorders. Furthermore, this review searched for original reports focusing on possible therapeutic and preventative
effects of probiotics for these debilitating conditions. Accumulating data indicate that the gut microbiota communicates
with the CNS through neural, endocrine and immune pathways. Studies in germ-free animals indicate that the microbiota
is involved in the regulation of the stress response (e.g., hypothalamic-pituitary-adrenal axis) and in CNS development at
critical stages. Probiotics attenuate anxiety and depressive-like behaviors in experimental animal models. Notwithstanding
some inconsistencies and methodological limitations across trials, clinical studies suggest that probiotics may mitigate
anxiety symptoms. However, future studies should investigate the anxiolytic and antidepressant effects of probiotics in
more phenotypically homogeneous populations. In conclusion, the emerging concept of a gut microbiota-brain axis
suggests that the modulation of the gut microbiota may provide a novel therapeutic target for the treatment and/or
prevention of mood and anxiety disorders.

Abstract:A priority clinical and research agenda in mood and anxiety disorders is to identify determinants that influence
illness trajectory and outcome. Over the past decade, studies have demonstrated a bidirectional relationship between the
gut microbiome and brain function (i.e., the microbiota-gut-brain axis). Probiotic treatments and developmental analysis
of the microbiome may provide potential treatments and preventative measures for depressive and anxiety disorders. This
systematic literature review aims to identify original studies linking the gut microbiota to major depressive disorder and
anxiety disorders. Furthermore, this review searched for original reports focusing on possible therapeutic and preventative
effects of probiotics for these debilitating conditions. Accumulating data indicate that the gut microbiota communicates
with the CNS through neural, endocrine and immune pathways. Studies in germ-free animals indicate that the microbiota
is involved in the regulation of the stress response (e.g., hypothalamic-pituitary-adrenal axis) and in CNS development at
critical stages. Probiotics attenuate anxiety and depressive-like behaviors in experimental animal models. Notwithstanding
some inconsistencies and methodological limitations across trials, clinical studies suggest that probiotics may mitigate
anxiety symptoms. However, future studies should investigate the anxiolytic and antidepressant effects of probiotics in
more phenotypically homogeneous populations. In conclusion, the emerging concept of a gut microbiota-brain axis
suggests that the modulation of the gut microbiota may provide a novel therapeutic target for the treatment and/or
prevention of mood and anxiety disorders.